Index of drugs

As an agent of general anesthesia: as a monoanesthetic for short-term surgical procedures, painful dressing changes (including burns and children), in diagnostic procedures; for repeated anesthesia in the same patient; under anesthesia complex in combination with other drugs (benzodiazepines, barbiturates, neuroleptics); in the introduction of general anesthesia. Used with good effects in severe, refractory to conventional treatment of bronchospasm. Often used in pediatric anaesthesiology and in patients with difficult access to veins for introduction into anesthesia by the intramuscular route. As an introducer to general anesthesia, it is recommended in patients with shock, oligovolemia, in selected situations of increased operational risk, and can be used under anesthesia for caesarean section, in patients with asthma, porphyria. Considered a very good agent for anesthesia in field conditions and in the case of mass injuries (cadastrophe). It should be used after premedication with atropine (due to increased salivation). In adults, combinations with benzodiazepines (eg diazepam, midazolam), neuroleptics (eg dehydrobenzperidol) or barbiturates are recommended to reduce or abolish unpleasant visions and dreams associated with ketamine anesthesia. At a concentration of 10 mg / ml, it is mainly used for intravenous administration.

1 vial of 20 ml contains 200 mg of ketamine hydrochloride (1 ml = 10 mg of ketamine); 1 vial of 10 ml contains 500 mg of ketamine hydrochloride (1 ml = 50 mg of ketamine).

A phencyclidine derivative with anesthetic and cataleptic effects. By acting on o.u.n. (mainly the limbic system and the cerebral cortex) causes the so-called dissociated anesthesia manifested by the disappearance of physical activity, separation from the outside world, desynchronised stimulation of some centers o.u.n., abolition of pain and consciousness. Patients may have open eyes during anesthesia with ketamine, eyes fixed on one point or horizontal-onset nystagmus, give the impression of being conscious (but with no contact or significantly reduced contact), with a reduced or suppressed reaction to pain. Ketamine does not tolerate visceral pain, causes activation of the sympathetic system, increase in blood pressure, increased heart rate, increased salivation, throat reflexes and laryngeal reflexes, increased intracranial pressure and cerebral blood flow, increased intraocular pressure, elevated noradrenaline blood levels, increased muscle tone. It acts psychologically, changes the image of EEG (changes in electrical activity within the cerebral cortex and the thalamus, without affecting the electrical activity of the brainstem). It does not have a significant depressive effect on the respiratory system, it allows effective maintenance of airway patency (however, there is a risk of aspiration or glottis due to increased salivation, oversensitivity of the supraglottic region and larynx to stimuli and suppression of the cough reflex). The beginning of anesthesia (loss of consciousness) after intravenous administration occurs in about 10-15 sec. and it lasts 5-10 min. after intramuscular administration occurs after a few minutes. and it lasts 20-40 min .; after which drowsiness persists for several hours. The Next doses of ketamine work with the same strength - there is no weakening or summation of the effect. Metabolized in the liver (dehydroxylation, N-demethylation) to norketamine (the so-called metabolite I with anesthetic activity of about 1/3 ketamine) and three further intermediate metabolites; metabolites (in about 90%) excreted in the urine, 5% of the drug excreted by the kidneys in unchanged form. T_0,5 about 3-4 h. Ketamine solutions do not irritate the tissues, pH of the 10% solution is 3.5-5.5.

Hypertension (fixed or systolic above 160 mmHg before surgery), heart failure, epilepsy, EPH gestosis, eclampsia or threaten eclampsia (EI) at delivery, upper respiratory tract infection, intracranial hypertension (also in patients with / after a stroke and immediately after craniocerebral injuries), after cerebrovascular disorders, larynxal surgery.Ketamine should not be used in alcoholics, alcoholic delirium or psychosis.

Ketamine crosses the placenta, which should be taken into account during surgical procedures during pregnancy. There were no controlled clinical trials in pregnant women, except during cesarean section or delivery. Due to the lack of safety data, the preparation is not recommended in pregnant or breast-feeding women.

During anesthesia with ketamine there are: increased tension of transverse striated muscles, involuntary movements, nystagmus, hypersensitivity to sounds. There may be: nausea, salivation, dreams and psychotic visions with unpleasant content, catatonia, psychomotor agitation, convulsions, epilepsy attack. There is an increase in reflexes from the throat and larynx. Short-term apnea or other transient breathing disorders may occur. Increased catecholamine concentration causes tachycardia, increase in blood pressure, bronchial dilation.

Individual doses depending on the indications and condition of the patient. Usually: (adults and children) - intravenously: 0.5-2.0 mg / kg m.c., in repeated doses ranging from 1/4 to the full initial dose every 5-15 minutes, depending on the need and duration of the treatment; intramuscularly: 5-10 mg / kg m.c. optionally, continuing anesthesia with repeated doses intravenously. In selected clinical situations, continuous IV infusion can be used at a dose of 2-6 mg / kg / h.